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BLANKO PERMOHONAN SURAT UJI ETIK

FAKULTAS KEPERAWATAN DAN KEBIDANAN


UNIVERSITAS NAHDLATUL ULAMA SURABAYA

Nama : …………………………………………………………………………………………..............
NIM : ……………………………………….………………………………………………................
Tahun Akademik : …………………………………………................................................................
Tingkat / Semester : …………………………………………………/…………………...................................
Program Studi : ............................................................................................................
Judul : ............................................................................................................
............................................................................................................
............................................................................................................

Pemohon,

( ………………………………. )

BLANKO PERMOHONAN SURAT UJI ETIK


FAKULTAS KEPERAWATAN DAN KEBIDANAN
UNIVERSITAS NAHDLATUL ULAMA SURABAYA

Nama : …………………………………………………………………………………………..............
NIM : ……………………………………….………………………………………………................
Tahun Akademik : …………………………………………................................................................
Tingkat / Semester : …………………………………………………/…………………...................................
Program Studi : ............................................................................................................
Judul : ............................................................................................................
............................................................................................................
............................................................................................................

Pemohon,

( ………………………………. )